Provider Demographics
NPI:1063443356
Name:REDDY, MITTA ANANTH (MD)
Entity Type:Individual
Prefix:DR
First Name:MITTA
Middle Name:ANANTH
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N RACE ST
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-3483
Mailing Address - Country:US
Mailing Address - Phone:270-651-4444
Mailing Address - Fax:270-651-4229
Practice Address - Street 1:1301 N RACE ST
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-3483
Practice Address - Country:US
Practice Address - Phone:270-651-4444
Practice Address - Fax:270-651-4229
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19502207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64195027Medicaid
KYP00119850OtherRAILROAD MCARE
KY000000052139OtherANTHEM
KY64195027Medicaid
KY000000052139OtherANTHEM